Patient Education


Warming Up, Cooling Down, and Stretching

Warming Up

Prior to exercise there should always be a warm up period.  Increasing body temperature will cause vasodilation and increases blood flow to muscle. This will improve muscle performance by increase the level of oxygen available for muscle contraction. It also improves elasticity of muscles, tendons and ligaments which will decrease risk of injury.


Stretching prior to exercise has long been thought to be beneficial. There are a couple of common misconceptions. Stretching should always be done after a short warm up. Stretching a cold muscle could cause an injury. There are two basic types of stretches: Static stretching and Dynamic Stretching. A static stretch is basically holding a muscle in an elongated position for 10-15 seconds. This has not been found to be beneficial prior to exercise and recent studies have shown that it decreases performance.

A dynamic stretch is moving a muscle through a full, even exaggerated range of motion that mimics the motion of the exercise. It may be done in a slower and more controlled way to avoid injury. Examples of dynamic stretches would be high knees, heel kicks or lunges. Aggressive dynamic stretches should be done in a progressive fashion after a slight warm up. (See link below)

Static stretching is still though to be beneficial after a work out and it should be done gently and pain free. When recovering from an injury, it is also important to warm up a muscle exogenously (heating pad) and gently statically stretch the involved muscle to restore normal flexibility.

Most experts advise warming up at about 40% of your maximum heart rate and progressing to about 60%. An aerobic warm up should take only 5-10 minutes with a 5 minute recovery.

Cooling down

Cooling down after exercise is important for 2 reasons. A period of light exercise after a workout continues good blood flow to help remove lactic acid which aids recovery. It also prevents a sudden drop in blood pressure which can result from sudden pooling of blood in muscle when it suddenly stops contracting. The contraction of muscle aids in returning blood back to the heart. The blood vessels in the large muscles are dilated during exercise and take a while to contract after the exercise has stopped.


Link for dynamic stretch:


ITB Syndrome

ITB syndrome is inflammation of the Iliotibial Band which is a fascial band which originates along the lateral (outside) aspect of the pelvis and inserts just below the knee. It presents as a burning or aching pain along the lateral aspect of the knee during activities and is a common cause of knee pain in runners and bikers. Actually a friction syndrome, it results from repetitive rubbing of the band along the lateral aspect of the distal femur. Prognosis is more favorable than other knee injuries since the problem is outside the joint and it usually responds well to treatment. It can be caused by over training and certain people are anatomically predisposed but basically the band is too tight. Running on a banked surface or circular track running can put you at risk. In cycling, having the feet “toed-in” to an excessive angle or having a seat that is too high or too far back can also contribute.

Treatment is directed at temporarily avoiding painful activities, icing after exercise and stretching the ITB.


This link will show you some good stretches.,7120,s6-241-285–11642-0,00.html


Strengthening the hip abductors may also prevent recurrences.×400



The sciatic nerve is large nerve that originates from several nerve roots in the lumbosacral spine or lower back. Sciatica is inflammation of the nerve. The inflammation is typically caused by either a herniated disc or a bone spur that pinches the nerve root as it comes out of the spinal chord. Classic symptoms from sciatica are pain running from your buttock down your leg often into the calf or foot and numbness and tingling in the leg. It usually involves only one leg and if it gets severe can cause weakness in the leg. Onset can be acute or gradual. It is often accompanied by lower back pain, but symptoms can vary considerably.

Treatment is focused on decreasing pressure on the disc. This means temporarily avoiding bending, twisting, stopping and lifting. Sitting correctly is also critical to minimizing disc pressure. This means sitting in a chair that has a good lumbar support to maintain the curvature of the lower back and avoid leaning forward at your desk which increases pressure in the disc. You should try to minimize sitting in general, avoid soft chairs or sofas and get up and move around every 20 -30 minutes. Standing, walking or lying down puts less pressure on the disc.

Core exercises are a key to avoiding back problems, but if you’re in acute pain, these should be done with caution and probably with supervision of a physical therapist. They are really more important in avoiding recurrence.


Tip for Runners – A disc is more likely to herniate if you run first thing in the morning. This is the time when the disc is most full of fluid. Your body fluids equalize from being recumbent overnight. Running on a soft surface will put less pressure on the disc.


Tip for Bikers – Bending at the waist instead of the lower back will put less pressure on the disc. Strengthening your core is also key.


Tips for Swimmers – Swimming general is good for back problems. If you’re having a problem, avoid flip turns which require a lot of lower back flexion.


Matt Gavin, MD
224D Cornwall St. NW, #204
Leesburg, VA 20176
Phone: 703-777-3262

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